Non-pharmacological interventions for improving sleep quality in adults aged 50 years and older: a systematic review and network meta-analysis

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BACKGROUND: Sleep disturbances are highly prevalent among adults aged 50 years and older and are associated with substantial public health burdens, including impaired cognitive function, reduced quality of life, and increased healthcare utilization. Although non-pharmacological treatments (NPTs) are increasingly recommended as first-line strategies, their comparative effectiveness and optimal implementation characteristics remain unclear. This study aimed to systematically compare the efficacy and acceptability of NPTs for improving sleep quality in adults aged 50 years and older. METHODS: A systematic review and Bayesian network meta-analysis of randomized controlled trials were conducted using PubMed, MEDLINE, Embase, Cochrane CENTRAL, and Web of Science from inception to April 1, 2025. Eligible trials enrolled adults aged 50 years and older with sleep disturbances (Pittsburgh Sleep Quality Index ≥ 5) and evaluated one of 25 predefined NPTs. Global sleep quality was analyzed using standardized mean differences, and all-cause dropout was assessed using risk ratios under random-effects models. A minimum clinically important difference was defined as a standardized mean difference of -0.89. Restricted cubic spline meta-regression was used to examine nonlinear associations with baseline sleep severity and intervention frequency. RESULTS: A total of 132 randomized controlled trials including 10,872 participants were included. Nineteen NPTs significantly improved sleep quality compared with control conditions. Combined aerobic and resistance training demonstrated the largest effect (standardized mean difference -1.56; 95% credible interval -2.08 to -1.03). Fourteen interventions met or exceeded the minimum clinically important difference; only combined aerobic and resistance training, acupressure, and aerobic exercise alone significantly surpassed this threshold. Meta-regression indicated maximal benefit at a baseline Pittsburgh Sleep Quality Index score of approximately 16 and with daily intervention delivery. Only usual care was associated with a lower dropout rate compared with control. CONCLUSION: Combined aerobic and resistance training, acupressure, and aerobic exercise showed the strongest benefits and most consistently exceeded the minimum clinically important difference in adults aged 50 years and older. Other NPTs also improved sleep quality and may be clinically useful in appropriate settings. Prioritizing individuals with moderate-to-severe sleep disturbance and implementing daily interventions may optimize population-level sleep outcomes. TRIAL REGISTRATION: PROSPERO CRD420251046892.

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